Skip to main content

Advertisement

SpringerLink
Log in

Association Between Small Intestinal Bacterial Overgrowth and Peripheral Bacterial DNA in Cirrhotic Patients

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Small intestinal bacterial overgrowth (SIBO) is regarded as the major risk factor of bacterial translocation. Few studies have investigated the direct relation between SIBO and translocation in cirrhotic patients. The purpose of this study is to examine the correlation between SIBO and bacterial DNA in the peripheral blood of patients with cirrhosis.

Aims

The purpose of this study is to examine the correlation between SIBO and bacterial DNA in the peripheral blood of patients with cirrhosis.

Methods

Fifty-three cirrhosis cases and 42 controls underwent a lactulose breath test (LBT) every 15 min for 180 min. To detect and identify the presence of bacterial DNA fragments in peripheral blood, multiplex polymerase chain reaction (PCR) was performed.

Results

The positive rate of LBT was significantly different between the two groups: 60.4% in the patient group and 28.6% in the controls. The SIBO positive rate was 81.3% in the cirrhosis patients with ascites, which was significantly higher than 51.4% in the cirrhosis patients with no ascites (P = 0.03). Eight of the nine patients (88.9%) who had a history of one or more hepatic encephalopathy was SIBO-positive, which was higher than the patients who had had no hepatic encephalopathy. In the cirrhosis group, 32 patients (60.4%) were SIBO-positive, and ten of them (31.3%) were bacterial DNA-positive. Only one case (4.8%) was bacterial DNA-positive in the absence of SIBO-positive. In a multivariate analysis, only the existence of SIBO was the independent risk factor for bacterial DNA (P = 0.026).

Conclusions

SIBO in cirrhosis patients was observed at a very high frequency, and SIBO showed a high correlation with bacterial translocation, suggesting that SIBO could be a major risk factor of bacterial translocation, especially in ascitic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Wiest R, Garcia-Tsao G. Bacterial translocation (BT) in cirrhosis. Hepatology. 2005;41:422–433. doi:10.1002/hep.20632.

    Article  CAS  PubMed  Google Scholar 

  2. Guarner C, Soriano G. Bacterial translocation and its consequences in patients with cirrhosis. Eur J Gastroenterol Hepatol. 2005;17:27–31. doi:10.1097/00042737-200501000-00006.

    Article  CAS  PubMed  Google Scholar 

  3. Gou YZ, Lian JQ, Nie QH. Bacterial translocation and its consequences in patients with liver cirrhosis. Zhonghua Gan Zang Bing Za Zhi. 2006;14:796–797.

    PubMed  Google Scholar 

  4. Francés R, González-Navajas JM, Zapater P, et al. Translocation of bacterial DNA from Gram-positive microorganisms is associated with a species-specific inflammatory response in serum and ascitic fluid of patients with cirrhosis. Clin Exp Immunol. 2007;150:230–237.

    PubMed  Google Scholar 

  5. Guarner C, Runyon BA, Young S, Heck M, Sheikh MY. Intestinal bacterial overgrowth and bacterial translocation in cirrhotic rats with ascites. J Hepatol. 1997;26:1372–1378. doi:10.1016/S0168-8278(97)80474-6.

    Article  CAS  PubMed  Google Scholar 

  6. Cirera I, Bauer TM, Navasa M, et al. Bacterial translocation of enteric organisms in patients with cirrhosis. J Hepatol. 2001;34:32–37. doi:10.1016/S0168-8278(00)00013-1.

    Article  CAS  PubMed  Google Scholar 

  7. Yang CY, Chang CS, Chen GH. Small-intestinal bacterial overgrowth in patients with liver cirrhosis, diagnosed with glucose H2 or CH4 breath tests. Scand J Gastroenterol. 1998;33:867–871. doi:10.1080/00365529850171549.

    Article  CAS  PubMed  Google Scholar 

  8. Bauer TM, Steinbrückner B, Brinkmann FE, et al. Small intestinal bacterial overgrowth in patients with cirrhosis: Prevalence and relation with spontaneous bacterial peritonitis. Am J Gastroenterol. 2001;96:2962–2967. doi:10.1111/j.1572-0241.2001.04668.x.

    Article  CAS  PubMed  Google Scholar 

  9. González-Navajas JM, Francés R, Such J. Bacterial DNA in patients with cirrhosis and sterile ascites. Its role as a marker of bacterial translocation and prognostic tool. Rev Esp Enferm Dig. 2007;99:599–603.

    Article  PubMed  Google Scholar 

  10. Guarner C, González-Navajas JM, Sánchez E, et al. The detection of bacterial DNA in blood of rats with CCI4-induced cirrhosis with ascites represents episodes of bacterial translocation. Hepatology. 2006;44:633–639. doi:10.1002/hep.21286.

    Article  CAS  PubMed  Google Scholar 

  11. Hwang IT, Kim YJ, Kim SH, et al. Annealing control primer system for improving specificity of PCR amplification. Biotechniques. 2003;35:1180–1184.

    CAS  PubMed  Google Scholar 

  12. Lin HC. Small intestinal bacterial overgrowth: A framework for understanding irritable bowel syndrome. JAMA. 2004;292:852–858. doi:10.1001/jama.292.7.852.

    Article  CAS  PubMed  Google Scholar 

  13. Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. A double-blind, randomized, placebo-controlled study. Am J Gastroenterol. 2003;98:412–419.

    PubMed  Google Scholar 

  14. Paik CN, Choi MG, Nam KW, et al. The prevalence of small intestinal bacterial overgrowth in Korean patients with irritable bowel syndrome. Kor J Neurogastroenterol Motil. 2007;13:38–44.

    Google Scholar 

  15. Bauer TM, Schwacha H, Steinbrückner B, et al. Diagnosis of small intestinal bacterial overgrowth in patients with cirrhosis of the liver: Poor performance of the glucose breath hydrogen test. J Hepatol. 2000;33:382–386. doi:10.1016/S0168-8278(00)80273-1.

    Article  CAS  PubMed  Google Scholar 

  16. Quigley EM, Quera R. Small intestinal bacterial overgrowth: Roles of antibiotics, prebiotics, and probiotics. Gastroenterology. 2006;130:S78–S90. doi:10.1053/j.gastro.2005.11.046.

    Article  CAS  PubMed  Google Scholar 

  17. Bauer TM, Schwacha H, Steinbrückner B, et al. Small intestinal bacterial overgrowth in human cirrhosis is associated with systemic endotoxemia. Am J Gastroenterol. 2002;97:2364–2370. doi:10.1111/j.1572-0241.2002.05791.x.

    Article  PubMed  Google Scholar 

  18. Kim YJ, Kwak CI, Gu YY, et al. Annealing control primer system for identification of differentially expressed genes on agarose gels. Biotechniques. 2004;36:424–6, 428, 430 passim.

    Google Scholar 

  19. Chun JY, Kim KJ, Hwang IT, et al. Dual priming oligonucleotide system for the multiplex detection of respiratory viruses and SNP genotyping of CYP2C19 gene. Nucleic Acids Res. 2007;35:e40. doi:10.1093/nar/gkm051.

    Article  PubMed  CAS  Google Scholar 

  20. Heininger A, Binder M, Ellinger A, et al. Effect of comprehensive validation of the template isolation procedure on the reliability of bacteraemia detection by a 16S rRNA gene PCR. Clin Microbiol Infect. 2004;10:452–458. doi:10.1111/j.1469-0691.2004.00877.x.

    Article  CAS  PubMed  Google Scholar 

  21. Nikkari S, McLaughlin IJ, Bi W, et al. Does blood of healthy subjects contain bacterial ribosomal DNA? J Clin Microbiol. 2001;39:1956–1959. doi:10.1128/JCM.39.5.1956-1959.2001.

    Article  CAS  PubMed  Google Scholar 

  22. Francés R, Zapater P, González-Navajas JM, et al. Bacterial DNA in patients with cirrhosis and noninfected ascites mimics the soluble immune response established in patients with spontaneous bacterial peritonitis. Hepatology. 2008;47:978–985. doi:10.1002/hep.22083.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Eulji University, Eulji Hospital, Seoul, Korea

    Dae Won Jun, Byoung Kwan Son, Seong Hwan Kim, Yun Ju Jo & Young Sook Park

  2. Department of Biomedical Science and Technology, Konkuk University, Seoul, Korea

    Kyung Tae Kim

  3. Department of Internal Medicine, Hanyang University College of Medicine, 17, Haengdang-dong, Seongdong-gu, Seoul, 133-792, Korea

    Oh Young Lee

  4. Laboratory Medicine, Eulji University, Eulji Hospital, Seoul, Korea

    Jeong Don Chae

Authors
  1. Dae Won Jun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyung Tae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Oh Young Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeong Don Chae
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Byoung Kwan Son
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seong Hwan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yun Ju Jo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Young Sook Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oh Young Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jun, D.W., Kim, K.T., Lee, O.Y. et al. Association Between Small Intestinal Bacterial Overgrowth and Peripheral Bacterial DNA in Cirrhotic Patients. Dig Dis Sci 55, 1465–1471 (2010). https://doi.org/10.1007/s10620-009-0870-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-009-0870-9

Keywords

Search

Navigation